Facility Evaluation Report

At approximately 1405: Licensing Program Analyst (LPA) Amy Goldenberg arrived to the facility to conduct an annual inspection. LPA was greeted at the door by a caregiver Katrina Mendoza and granted entry. LPA learned that there are one (1) caregiver and four (4) clients present during this inspection. LPA was later met by Rosario Maniquis, Administrator. Four clients and one staff interviews were conducted during this visit.

Approximately 1425- LPA began review of resident records. Four (4) records were reviewed. LPA reviewed for admission agreement, medical assessment and TB test results, consent forms, identification and emergency information, appraisal needs and service plans, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification.

Approximately 1450- LPA began review of employee records. One (1) record was reviewed. LPA reviewed employee record for first aid certification, finger print clearance, personnel/job application, health screening and TB test results, criminal record statement, employee rights, training verification, and current administrator certification.

CPR and annual training requirements have been met. The facility employs enough staff to maintain cleanliness and meet the needs of the residents in care. The facility administrator is present a sufficient number of hours to maintain the facility. Administrator certification is present.

Approximately 1530: LPA toured the facility inside and outside. LPA observe the facility to be clean and in good repair. The home is maintained at a comfortable temperature for the residents.